Chiropractic Manipulation Causing Anterior-Posterior Compression Type Pelvic Ring Injury: A Case Report.

CASE: We present a case of an anteroposterior compression (APC) type pelvic ring injury that occurred after chiropractic manipulation in a patient with a history of quadriplegia. Emergent surgical stabilization was undertaken, and he had an excellent outcome with no complications at 3.5-year follow-up. CONCLUSION: APC type pelvic ring injuries usually occur to high-energy mechanisms. We describe a case of a patient with quadriplegia and osteopenia that suffered a pelvic ring injury because of a unique mechanism. Practitioners performing pelvic manipulation should be aware of this type of injury in at-risk patients.

A retrospective study about functional outcome and quality of life after surgical fixation of insufficiency pelvic ring injuries.

BACKGROUND: Fragility fractures without significant trauma of the pelvic ring in older patients were often treated conservatively. An alternative treatment is surgery involving percutaneous screw fixation to stabilize the posterior pelvic ring. This surgical treatment enables patients to be mobilized quickly and complications associated with bedrest and temporary immobility are reduced. However, the functional outcome following surgery and quality of life of the patients have not yet been investigated. Here, we present a comprehensive study addressing the long-term well-being and the quality of life of patients with fragility pelvic ring fractures after surgical treatment. METHODS: Between 2011-2019, 215 geriatric patients with pelvic ring fractures were surgically treated at the university hospital in Göttingen (Germany). Of these, 94 patients had fragility fractures for which complete sets of computer tomography (CT) and radiological images were available. Fractures were classified according to Tile and according to the FFP classification of Rommens and Hofmann. The functional outcome of surgical treatment was evaluated using the Majeed pelvic score and the Short Form Health Survey-36 (SF-36). RESULTS: Thirty five tile type C and 48 type B classified patients were included in the study. After surgery eighty-three patients scored in average 85.92 points (± 23.39) of a maximum of 100 points using the Majeed score questionnaire and a mean of 1.60 points on the numerical rating scale ranging between 0 and 10 points where 0 points refers to "no pain" and 10 means "strongest pain". Also, the SF-36 survey shows that surgical treatment positively effects patients with respect to their general health status and by restoring vitality, reducing bodily pain and an increase of their general mental health. CONCLUSIONS: Patients who received a percutaneous screw fixation of fragility fractures of the posterior pelvic ring reported an overall positive outcome concerning their long-term well-being. In particular, older patients appear to benefit from surgical treatment. TRIAL REGISTRATION: Functional outcome and quality of life after surgical treatment of fragility fractures of the posterior pelvic ring, DRKS00024768. Registered 8th March 2021 - Retrospectively registered. Trial registration number DRKS00024768 .

Acetabular distraction: an alternative for severe acetabular bone loss and chronic pelvic discontinuity.

Acetabular bone loss is a challenging problem facing the revision total hip replacement surgeon. Reconstruction of the acetabulum depends on the presence of anterosuperior and posteroinferior pelvic column support for component fixation and stability. The Paprosky classification is most commonly used when determining the location and degree of acetabular bone loss. Augments serve the function of either providing primary construct stability or supplementary fixation. When a pelvic discontinuity is encountered we advocate the use of an acetabular distraction technique with a jumbo cup and modular porous metal acetabular augments for the treatment of severe acetabular bone loss and associated chronic pelvic discontinuity.

CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT.

PURPOSE: To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. MATERIAL AND METHODS: Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. RESULTS: A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1,10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14 -52 minutes) and 35 minutes (range: 21 - 60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy â€Š× â€Šcm (range: 162 - 1014 mGy  ×  cm) for the unilateral and 470 mGy  ×  cm (range: 270 - 1271 mGy  × â€Šcm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7  %). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). CONCLUSION: CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention.

Evolution of pelvic and acetabular surgery from ancient to modern times.

Fracture stabilisation before the 19th century was in its infancy. The outcome was suboptimal, and quite often mortality was the end result. Advances in the stabilisation of long-bone fractures did not become apparent until the mid-1940s and for other bones, even later. In the mid-1960s, Judet and Letournel initiated a series of experimental and clinical studies focusing on pelvic and acetabular reconstruction surgery. Their work set the pace for all the subsequent advancements made in this field of surgery. Today, pelvic and acetabular reconstruction is a recognised subspecialty within the disciplines of trauma and orthopaedics. This review article traces the evolution of pelvic and acetabular surgery, from ancient to modern times.

[Open pelvic fracture. Treatment strategy and results for 12 patients]. / Die offene Beckenfraktur. Behandlungsstrategie und Resultate anhand von 12 Patienten.

This article presents treatment priorities for open pelvic fracture and the results of 12 patients. In a retrospective study we analyzed 12 patients treated at a level 1 trauma center between 1994 and 1998 of whom eight were male and four female with an average age of 29.6 years. Six type C (6 x III degrees open) and six type B (4 x II degrees and 2 x III degrees open) were identified. On average, 15 EKs were necessary within the first 12 h of treatment (type C=17, type B=13). All type C fractures underwent emergency stabilization with the pelvic C-clamp. Early laparotomy was performed in 60%. Perineal laceration was identified in 58%, followed by nerve and plexus lesions in 42%, injuries of the genitourinary tract in 33%, and lesions of the fecal stream in 25%. Altogether, there were more peripelvic injuries associated with type C fracture than with type B (12 vs 8). On average, there were 27 second-look operations necessary with 3-.2 operations per patient. The average stay in the ICU was 82 days (80-360); 25% died. Control of hemorrhage is fundamental; therefore, emergency stabilization of the pelvis is essential followed by surgical procedures. Early surgical definitive stabilization of the fracture decreases septic complications. Such complex injuries should be treated at specialized trauma centers.

Iliosacral screw fixation of the posterior pelvic ring using local anaesthesia and computerised tomography.

Various techniques have been used for the fixation of the posterior pelvis, each with disadvantages specific to the technique. In this study, a new protocol involving the placement of posterior pelvic screws in the CT suite is described and evaluated. A total of 66 patients with unstable pelvic ring injuries was stabilised under local anaesthesia with sedation. The mean length of time for the procedure was 26 minutes per screw. There were no technical difficulties or misplaced screws and no cases of infection or nonunion. All patients stated that they would choose to have the CT scan procedure again rather than a procedure requiring general anaesthesia. The charges for the procedure were approximately 1840 pounds sterling (2800 dollars) per operation. CT-guided placement of iliosacral screws is a safe, feasible, and cost-effective alternative to radiologically-guided placement in the operating theatre in selected patients.

[Operability of primary inoperable pelvic tumors by preoperative regional hyperthermia in combination with systemic chemotherapy exemplified by Ewing's sarcoma]. / Operabilität primär inoperabler Beckentumoren durch präoperative regionale Hyperthermie in Kombination mit systemischer Chemotherapie am Beispiel eines Ewing-Sarkoms.

Failure of local tumor control is of critical importance in the clinical management of large pelvic tumors. For bulky sarcomas of the pelvis a new treatment strategy could be of importance in the future using preoperative regional hyperthermia combined with systemic chemotherapy. In our case history of a patient with unresectable Ewing sarcoma of the pelvis no tumor response could be observed during multi-drug chemotherapy alone. However, after treatment with regional hyperthermia combined with systemic chemotherapy, the tumor mass became resectable and was separated from the adjacent tissue by a fibrotic pseudocapsule. Histological evaluation of the tumor tissue showed a complete change of the pattern.